Paging DR COPTR

It first appears as a smear on the horizon, barely visible through the helicopter’s windshield on the hazy expanse of the Chesapeake Bay. Soon an outline emerges, then houses, a church, white picket fences and a weedy, forlorn airstrip.

“That would be it,” says the pilot, David B. Nichols. He first visited this isolated place as a young doctor 27 years ago, when he promised people he would keep coming back to provide medical care.

They had seen other doctors come and go. He said he wouldn’t do that. He promised to be back.

And once a week, weather permitting, for almost three decades, he has flown the 25 miles from the mainland to this sun-bleached outpost in the middle of the bay.

He did so again one day last month - 58 now, with a shock of white hair - setting down on a storied island, where life and the weather can be harsh, and where the 600 or so residents still are haunted by vestiges of the strange disease to which Tangier gave its name 40 years ago.

It is a rare genetic illness that causes high cholesterol and heart disease, and while no one on the island officially has it, the symptoms seem to be widespread.

But Nichols treats many maladies here.

“We see everybody,” he jokes. “Young, old, beautiful, ugly.”

* * *

“Doctor,” comes the familiar retort, “you’re better than a thousand dead men.”

He hugs them. They caress his face and stroke his hands.

He’s not one of those 10-minute doctors, they say.

They are enchanting people, he says.

During his recent daylong visit, Nichols examined an 88-year-old woman with a broken shoulder, revived a 51-year-old waterman suffering from dehydration, and had a 37-year-old woman with a spinal fracture evacuated to a hospital in Maryland.

Tangier Island has had trouble getting good health care for years. It hasn’t had a full-time physician in decades, though its residents suffer from high levels of heart disease and diabetes, as well as the effects of hard days on the water hauling crabs from the bay.

The island’s medical facility, the Gladstone Memorial Health Center, is a one-story structure with creaky doors and water-stained ceilings that was dedicated in 1957. Records are kept in dog-eared folders on homemade wooden shelves. There is a cardboard file box labeled “DECEASED.” The waiting room has three Bibles.

“When I started coming here, I said I was going to come every week, come hell or high water,” says Nichols, a native of Canada. “Maybe one time a year I don’t get here, because I can’t get here by boat, I can’t get here by flight: It’s freezing, it’s windy, it’s a storm. One time it was a hurricane. People get to depend on you.”

* * *

Nichols moved to the area after medical school because his parents had retired to Virginia’s Northern Neck and he was sick of the winters in Winnipeg, his hometown.

For the first seven years of his practice, based in White Stone, near the mouth of the Rappahannock River, Nichols was the only doctor making the Tangier trip.

A longtime pilot, he most often would travel by plane. After partners joined the practice, they began rotating visits.

But Nichols, who goes every third week, does all the flying, now in his sleek new helicopter - call sign 555 zulu mike. The three fives stand for nickels and are a play on his last name. Zulu mike stands for ZM, which is short for zoom, he says. The license plate on his car reads “DR COPTR.”

* * *

Tangier is well known for its isolation, its peculiar dialect and the tight bonds of kinship and religion.

“We’re like a family,” says Dottie Evans. “When one hurts, we all hurt. When one’s happy, most all of us are happy.”

Forty years ago, the island gave its name to a rare genetic malady that first was identified in two local children. Tangier disease is the virtual absence in the body of so-called good cholesterol, which results in extremely high levels of the so-called bad cholesterol and extensive heart disease.

The illness is extremely rare - fewer then 100 actual cases are known - but on the island, the symptoms are not.

“This is the kind of stuff we see over here with great frequency,” Nichols says, “in the older people and sometimes the younger people. Probably some of it’s genetic.... There’s bound to be some bad mutant genes that probably hang in there and don’t get diluted out.”

The population has been isolated for centuries, and marriage outside the island has been minimal, he says.

Nichols says he intends to continue his visits as long as he can.

“The more I go, the more I like to go,” he says. “And the more I learn. I guess I didn’t really realize how great a place it was when I first went....  You get to feel part of the life. The other thing is, they need it. Who else is going to do it?”